Skills Training /Exposure in Childhood Abuse PTSD

描述(申请人提供)：创伤后应激障碍(PTSD)是一种 衰弱的，通常是慢性焦虑症，有严重的精神疾病 合并症。创伤后应激障碍的终生患病率估计为10% 女性和5%的男性。与创伤后应激障碍相关的最常见创伤 在女性中，儿童时期受到虐待。与儿童期虐待有关的创伤后应激障碍 在情绪调节和人际关系方面有实质性的障碍 功能正常。在儿童期虐待中有严重的功能障碍 患有创伤后应激障碍的幸存者，如糟糕的工作和关系史， 养育子女，以及以身体攻击的形式再次受害的高风险， 性侵犯和家庭暴力。不足为奇的是，这些人口 在精神健康服务中的比例明显过高。治疗研究 对于这一群体的创伤后应激障碍患者是迫切需要的。 首席研究员在NIMH基金的支持下，已经开发出一种治疗方法 这直接和有力地解决了创伤后应激障碍的三个不同的问题领域 与儿童期虐待有关：情绪管理问题、人际关系 问题和创伤后应激障碍。治疗分为两个阶段，提供8 情感和人际调节方面的技能培训(STAIR) 然后是8个疗程的改良版延长暴露(MPE)。 一项随机对照试验的结果发现，所有患者都有显著改善 三个目标区域。 拟议研究的主要目的是确定这一点 双组分处理优于仅使用其中一种的处理 治疗组件。与成人创伤相关的创伤后应激障碍的研究发现 联合治疗并不能提供任何优于它们的益处 组件。然而，干预措施的具体问题性质也是如此 治疗的顺序实施而不是同时实施 成分，表明这种联合治疗可能会产生更好的结果 比可比的单组分治疗更有效。 150名患有与儿童期虐待有关的创伤后应激障碍的妇女将 随机分配到三种有效治疗方法中的一种：楼梯/MPE，MPE 治疗条件和楼梯治疗条件。主要结果是 变量将针对三个问题领域：影响管理， 人际功能和创伤后应激障碍症状。我们亦会评估 每种治疗的可行性，以辍学率和是否存在 不良反应以治疗过程中症状恶化来衡量。

Description (provided by applicant): Post-traumatic Stress Disorder (PTSD) is a debilitating and often chronic anxiety disorder with serious psychiatric comorbidity. The lifetime prevalence of PTSD is estimated at 10 percent among women and 5 percent for men. The most frequent trauma associated with PTSD among women is childhood abuse. PTSD related to childhood abuse is associated with substantial disturbance in emotion regulation and interpersonal functioning. There is significant functional impairment among childhood abuse survivors with PTSD such as poor work and relationship histories, problems in parenting, and high risk for revictimization in the form of physical assault, sexual assault and domestic violence. Not surprisingly, this population is significantly over-represented in mental health services. Treatment research for this group of PTSD patients is urgently needed. The principal investigator, supported by NIMH funds, has developed a treatment that directly and vigorously addresses three distinct problem domains in PTSD related to childhood abuse: emotion management problems, interpersonal problems, and PTSD. The treatment, organized into two phases, provides 8 sessions of skills training in affect and interpersonal regulation (STAIR) followed by 8 sessions of a modified version of prolonged exposure (MPE). Results of a randomized controlled trial found significant improvement in all three targeted areas. The primary aim of the proposed study is to determine whether this two-component treatment is superior to treatments utilizing only one of the treatment components. Studies of PTSD related to adult-onset traumas have found that combination treatments do not provide any benefit superior to their components. However, the problem-specific nature of the interventions as well the sequential rather than simultaneous implementation of the treatment components, suggest that this combination treatment may produce better outcomes than comparable single-component treatments. One hundred and fifty (150) women with PTSD related to childhood abuse will be randomly assigned to one of three active treatments: STAIR/MPE, an MPE treatment condition, and a STAIR treatment condition. The primary outcome variables will target the three problem domains: affect management, interpersonal functioning and PTSD symptoms. We will also assess the feasibility of each treatment as measured by dropout rates and the presence of adverse effects as measured by symptom worsening over the course of treatment.